Provider Demographics
NPI:1710154687
Name:LILLICRAP, BETHANY ANN (MA, CCC-A, F-AAA)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:ANN
Last Name:LILLICRAP
Suffix:
Gender:F
Credentials:MA, CCC-A, F-AAA
Other - Prefix:MISS
Other - First Name:BETHANY
Other - Middle Name:ANN
Other - Last Name:CALLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-A, F-AAA
Mailing Address - Street 1:108 RUMMEL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NEW BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:45869-9669
Mailing Address - Country:US
Mailing Address - Phone:937-418-9273
Mailing Address - Fax:
Practice Address - Street 1:108 RUMMEL CREEK DR
Practice Address - Street 2:
Practice Address - City:NEW BREMEN
Practice Address - State:OH
Practice Address - Zip Code:45869-9669
Practice Address - Country:US
Practice Address - Phone:937-418-9273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist